12. Vagus Nerve Stimulation Therapy and Epilepsy Surgery

  1. James W. Wheless
  1. Kate Van Poppel and
  2. James W. Wheless

Published Online: 1 NOV 2012

DOI: 10.1002/9781119998600.ch12

Epilepsy in Children and Adolescents

Epilepsy in Children and Adolescents

How to Cite

Van Poppel, K. and Wheless, J. W. (2012) Vagus Nerve Stimulation Therapy and Epilepsy Surgery, in Epilepsy in Children and Adolescents (ed J. W. Wheless), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9781119998600.ch12

Editor Information

  1. Department of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Comprehensive Epilepsy Program and Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA

Author Information

  1. Department of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Comprehensive Epilepsy Program and Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA

Publication History

  1. Published Online: 1 NOV 2012
  2. Published Print: 23 NOV 2012

ISBN Information

Print ISBN: 9780470741238

Online ISBN: 9781119998600

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Keywords:

  • vagus nerve stimulation (VNS);
  • randomized controlled trial;
  • seizure;
  • implantation;
  • epilepsy surgery;
  • epileptogenic focus;
  • functional cortex

Summary

In this chapter we discuss the role of vagus nerve stimulation and epilepsy surgery. The history, efficacy, and outcomes of vagus nerve stimulation (VNS) are described, with reference to trials and studies in both humans and animals. Latest thinking on the therapeutic mechanism of VNS is outlined, and the salient aspects of patient selection, implantation of the device, and maintenance are presented, along with the advantages and drawbacks of this therapy. For children with medically intractable epilepsy, neurosurgical intervention may allow seizure control and in some cases even a cure. The phases of evaluating a child for epilepsy surgery are detailed: in phase I, patients are evaluated through non-invasive techniques to establish whether a patient is a candidate for epilepsy surgery. Phase II, which may not be necessary in some instances, involves invasive electrode monitoring for more precise localization of the epileptogenic zone in relation to functional cortex. Phase III involves the actual epilepsy surgery. The current modalities for evaluating not only the source of epileptogenesis but also the functional cortex, are outlined.